Funded Proposals--2007
Isaac M. Lipkus, Department of Psychiatry, Duke University Medical Center
Title: Effects of Providing Breast Cancer Recurrence Risk Using Oncotype DX on Patient Adjuvant Treatment Decisions
Abstract: The use of genomic information to guide disease treatment is increasing. For breast cancer, genetic profiling using assays such as Oncotype DX provide estimates of breast cancer recurrence. These estimates may help tailor treatment. Based on Oncotype DX, those with low recurrence risk benefit best from endocrine treatment than chemotherapy; those at higher recurrence may benefit most from chemotherapy with questionable added benefit from endocrine therapy. Do patients realize this? Given the nascent state of the science, it is important to begin to assess patient understanding of recurrence risk based on Oncotype DX and its consequences on treatment decisions. To address these issues, we will enroll over a two year period 50 early stage breast cancer patients who have estrogen receptor positive tumors with no node involvement receiving adjuvant treatment at Duke University Medical Center. They will be asked questions after receipt of the Oncotype DX result in the context of adjuvant treatment discussions their perceptions of recurrence risk, and perceived risks and benefits of chemotherapy and endocrine therapy. Our aims are to explore: 1) patients' accuracy of stating their recurrence risk based on the Oncotype DX, 2) how perceptions of recurrence risk affect weighing of treatment risks and benefits and treatment selection, and 3) how numeracy affects processes outlined in the two aims above. This pilot will obtain effect sizes to inform where errors in perceptions and judgment occur and hence in what areas to craft targeted interventions to improve informed decisions.
Pablo A. Mora, Institute for Health, Rutgers University
Title: Ethnicity and the Commonsense Model of Self-Regulation: An Examination of Ethnic Differences in Illness Representations of Chronic Conditions and Illness Management
Abstract: Evidence has shown that after controlling for differences in treatment attributable to insurance status, access to care, health status, and other factors, racial and ethnic health inequalities remain. Accordingly, if improvements are to be made in health outcomes, it is necessary to understand how culture and ethnicity including factors such as age, religious involvement, education, medical literacy and facets of the individual's life and health history shape perception of somatic changes and procedures for the management of health problems. The proposed studies are designed to determine how patients' illness and treatment representations impact the management of chronic illnesses. Specifically, I will examine how ethnic background may impact illness representations, coping procedures, and illness self-management behaviors. The studies are designed to investigate the relationship among illness representations and their impact on health outcomes in African-Americans, Hispanics, and European-Americans age 55+ who are suffering from diabetes and hypertension. To achieve project goals, I will conduct a series of field, non-experimental qualitative studies. These studies will examine cognitive and emotional aspects of both illness and treatment representations for hypertension and diabetes in the three aforementioned ethnic groups. In addition, we will determine how these representations shape the ways patients from different ethnic groups manage their illness conditions. Two types of studies will be carried out: (1) in-depth cognitive interviews, and (2) focus group interviews.
Michele L. Okun, University of Pittsburgh Medical Center
Title: Pregnancy-Related Sleep Disturbances may Increase Pregnancy Complications
Abstract: Pregnancy complications increase a woman's risk of future medical morbidities; they also place her infant at risk of developmental, neurological and respiratory abnormalities as well as increased mortality. Currently 26-29% of pregnant women will endure preeclampsia, gestational diabetes, preterm birth and/or have a baby that is growth restricted. Evaluation of un(der)explored risk factors and novel pathways that may account for the increased risk of pregnancy complications is a focus of several national agencies. One such novel risk factor and pathway may be disturbed sleep during pregnancy and concomitant increased inflammation. Disrupted sleep during pregnancy, characterized as poor sleep quality, increased fragmentation and short sleep duration, is associated with increased inflammation [Interleukin - 1β, -6, -8 and tumor necrosis factor alpha (TNF-α)]. Indeed, the same proinflammatory cytokines shown to be altered with sleep disruption are similarly reported in unusually high amounts in women with pregnancy complications. Despite these empirically supported relationships, there currently are scant published data linking disturbed sleep with pregnancy complications/outcomes. The foundation for the present project stems from independent areas of established research; the goal of this research is to empirically examine the role of sleep disturbances and increased inflammation in the pathogenesis of pregnancy complications. This goal will be accomplished by examining (1) the relationship between pregnancy-related sleep disturbances in the early gestational period and subsequent pregnancy complications; (2) the relationship between pregnancy-related sleep disturbances and inflammation during the first and second trimesters; and (3) examining if sleep-related increases in inflammation are associated with pregnancy complications.
Ann Pearman, Gerontology Institute, Georgia State University
Title: Memory Complaints in Older Adult Life-Singles versus Older Adult Couples and Widows
Abstract: As the population of the United States ages, the incidence of and concerns about memory impairment increase. This study is designed to explore memory complaints in life-single older adults. There are a couple of questions about whether life-single older adults may be at risk for not receiving diagnostic memory assessments. The first is that memory complaints have been shown to have a very social contextual component. That is, people with memory concerns tend to talk about these concerns with their spouse or children and these sources usually will encourage the individual to receive an assessment. Therefore, if a person does not have a spouse or children, are they at risk of non-detection of memory impairments? Secondly, one of the best diagnostic tools that memory experts use when identifying early dementia is an informant, who is also often a spouse or a child. If a life-single does not have a close companion to report changes in memory behavior to the memory assessment specialist, will the diagnosis be less accurate? This study is designed to examine the presentation of memory complaints in life-singles and to determine the accuracy of their informants in detecting memory impairment. Comparisons will be made to older widows and couples. This study will not only help in designing services for life-single older adults but will also further the understanding of the contextual variables involved in memory complaints.
Ilene C. Siegler, Department of Psychiatry, Duke University Medical Center
Title: Single Boomers
Abstract: The literature on the benefits of marriage is well-established, there is less attention to understanding how being single affects health and well-being for the current generation of Baby Boomers who are turning 60 in very large numbers. The UNC Alumni Heart Study (UNCAHS) cohort provides an opportunity to fill that gap. The UNCAHS is a study of 4,989 persons who attended the University of North Carolina at Chapel Hill in 1964-66 and had their personality measured at the time of college entry who joined the UNCAHS in 1987. In the past 20 years, 11 questionnaires have been collected that detail changes in marital status, health and well-being as this cohort has aged from 40 to 60 giving a clear picture of middle age. While 85% of the cohort is currently married, 15% have been single during midlife. This translates into 300 individuals who have been single from age 40-60, 100 who report themselves as living with a partner, 400 who report separation or divorce during the 20 year period and 50 who have been widowed. In the proposed study we will develop models to understand predictors of survival, health and well-being for the single boomers and then compare those models to the groups of formerly married and consistently married individuals. The models will include data from measures of personality in college, at age 42 and at age 47 as predictors of health and well-being at age 60.
Dara H. Sorkin, School of Medicine, University of California-Irvine
Title: How Well do the Never-Married Manage Chronic Disease? Health and Health Behavior Differences of Patients with Type 2 Diabetes
Abstract: Research suggests that never-married individuals enjoy psychological health and life satisfaction that is comparable to that of married individuals. Evidence is more mixed, however, as to how the never-married and married compare in terms of health. A crucial question that has received very little attention in this regard is whether the never-married fare as well as other marital status groups in managing a chronic illness, such as type 2 diabetes mellitus. Managing a chronic illness often requires people to make, and sustain, changes in multiple health behaviors. Maintaining the motivation to make such behavior changes, and coping with inevitable setbacks, can be challenging, and previous research has examined the role of the spouse in supporting, regulating, and influencing their partners' behavior change efforts. Relatively little research has examined whether never-married individuals derive similar benefits from non-spousal relationships in their efforts to meet the day-to-day demands of managing a chronic illness. The purpose of the current study is to examine how never-married vs. currently or previously married individuals manage chronic disease (specifically, type 2 diabetes), whether they have similar or different access to social support and regulation in their efforts to adhere to a long-term treatment regimen, and whether these social resources are just as effective among different marital status groups. Attention to these questions is particularly important in view of both the increasing number of never-married individuals in the population and the rising rates of chronic illness, including soaring increases in the prevalence of diabetes.